Provider Demographics
NPI:1508151499
Name:JANDHYALA, CHANAKYA KUMAR (MD)
Entity type:Individual
Prefix:
First Name:CHANAKYA
Middle Name:KUMAR
Last Name:JANDHYALA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:379 CAMPUS DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1161
Mailing Address - Country:US
Mailing Address - Phone:732-369-5994
Mailing Address - Fax:203-513-3269
Practice Address - Street 1:1251 ROUTE 37 W STE 250
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5050
Practice Address - Country:US
Practice Address - Phone:732-349-0988
Practice Address - Fax:732-244-7448
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10039661207X00000X
NY287826-1207XS0117X
NJ25MA11149700207X00000X
CT60101207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine